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"When is there going to be a birth control pill for men?" It's a question many women have asked when faced with the myriad contraceptive choices that make pregnancy prevention their responsibility. And many men want to know when they will have more options for controlling their fertility.
The good news is researchers are making strides in creating viable new male contraceptives — a move that will give both women and men more flexibility in preventing pregnancy.
One Egg, Millions of Sperm
Every pregnancy needs a sperm and an egg, but women have the most options for preventing pregnancy, while the only methods that are male-reliant are condoms, vasectomy, withdrawal, and periodic abstinence. By contrast, women have a multitude of barrier and hormonal methods open to them. According to Dr. Narender Kumar of the Population Council, a New York City-based nonprofit group that researches sustainable population growth, most contraceptives are aimed at women because of biological necessity.
"Females release one egg per menstrual cycle, but males make millions and millions of sperm a day," says Kumar. It's considerably easier to control a single egg than millions of sperm.
But even though gearing birth control toward women may be technologically simpler, studies show that an increasing number of men want to take an active role in contraception. "Men are more interested in having sex than in being fathers at most points in their lives," claims Dr. John Amory, assistant professor of internal medicine at the University of Washington in Seattle. Nevertheless, he says, only about a third of contraception is male-reliant.
Amory points out that what's missing for men is something analogous to the birth control pill, a hormonal method widely used by women since the 1960s. Hormonal methods like the pill, ring, patch, and shot, are 99.7 percent effective against pregnancy when used correctly, and are easily reversible — unlike vasectomy, which is difficult and expensive to reverse, and cannot be reversed at all in some men.
Turning Down Testosterone
At the University of Washington's Male Contraception Research Center, Amory and other scientists are currently working on a hormonal method of birth control for men. The most promising research, he says, focuses on using excess testosterone to turn off sperm production.
The testicles produce their own testosterone supply, based on signals coming from the pituitary gland in the brain. The testosterone produced in the testicles leads to sperm production. But if testosterone is injected directly into the bloodstream, it sends signals to the pituitary gland saying that the level of testosterone is too high. The pituitary gland then signals the testicles to slow down testosterone production, which in turn, turns off sperm production.
Armory and other researchers have found that this mechanism decreases sperm production in about two-thirds of men, with few side effects. But in order for testosterone shots to be used as a reliable form of contraception, the shots will need to be substantially more effective in lowering sperm production.
However, researchers believe that adding the hormone progesterone to the testosterone shots may lower sperm counts enough in the majority of men to produce a considerably effective form of contraception. In parts of Europe and Canada, clinical trials are currently taking place to test the effectiveness and safety of this testosterone-progesterone combination.
Pills and Vaccines
Scientists theorize that putting testosterone and progesterone into a shot, a patch, or an implant (like the upcoming Implanon for women) could work well to lower sperm counts. But since digestion degrades testosterone, putting hormones into a pill wouldn't work. That's why some researchers are working on oral and non-hormonal methods that will lower sperm counts or, alternatively, make sperm unable to fertilize an egg.
Kumar says scientists have found that oral drugs used for other purposes, such as treating cancer or high blood-pressure, can lower sperm count. One drug in particular, Lonidamine, has shown particular promise in shutting down sperm production. However, the drug has potentially toxic side effects, a problem that obviously must be resolved before prescribing it as a contraceptive.
Another promising alternative is to immunize men against proteins necessary for fertilization, a method that has already worked in monkeys. Scientists at the University of Washington published research last November showing that creating an immune response against eppin, a protein on the outside of sperm, caused most of the monkeys in their study to become infertile.
When the researchers stopped giving booster shots of the vaccine, most of the monkeys regained their fertility. However, since the treatment made some monkeys permanently infertile, the scientists say studies with eppin have a long way to go before researchers try a similar method on humans.
Keep Your Condoms
Since research into a hormonal contraceptive is progressing faster than other methods, Amory says he expects the first male birth control drugs based on the testosterone/progesterone mixture to be available in about five years. However, he notes, male birth control — like hormonal birth control for women — won't offer any protection against sexually transmitted infections, making it unlikely that using an old-fashioned condom will go out of style any time soon.